Meckel's diverticulum: An analysis of eighteen cases with report of one tumor

Abstract

The lesions of this common anomaly are so manifold that it should be entertained in every puzzling abdominal diagnosis. Because of its varied and bizarre morbid states, no one definite syndrome can be ascribed to it. The recent numerous articles on the subject have given this frequent and dangerous anomaly a deserved place, for more and more think of it in differential diagnoses. In reviewing the literature, one is impressed with the frequency of secondary laparotomies following appendectomy or salpingectomy, etc., for the removal of a troublesome Meckel's diverticulum. Many unnecessary operations and failure of an appendectomy to relieve vague abdominal pains have been now explained by the fact that a Meckel's diverticulum was overlooked. Surgeons have not searched for this frequent anomaly, estimated as occurring in 1.5 to 3 per cent of all persons. The argument “to leave well enough alone” is to be condemned, for the diverticulum resembles and yet is so unlike the appendix, that when both are present, the chance of morbid pathology in the diverticulum because of its position, structure and development, is tenfold that of the appendix vermicularis. The appendix, however, is removed at laparotomy in the majority of cases; a second operation, therefore, is deprecated. The diagnosis could be made more frequently, for quite often the “sign on the door” is overlooked. The presence of an umbilical adenoma, a history of fecal discharge from the umbilicus or of cryptic rectal hemorrhages should be pointers. The admonition of Cullen remains unheeded. In his book, “The Umbilicus and its Diseases,” the following paragraph appears in large print: In every case of umbilical polyp it is the duty of the family physician or surgeon to explain carefully to the parents the possible coexistence of an intra-abdominal portion of the omphalomesenteric duct, which may be adherent to the umbilicus and later give rise to intestinal obstruction. Their parents should be instructed to watch such children carefully, and if later in life the slightest sign of intestinal obstruction develops an abdominal operation should be immediately undertaken, the surgeon making an incision encircling the umbilicus and looking immediately for an adherent Meckel's diverticulum. If this review and analysis of cases does nothing more than impress the reader with the necessity of looking for a Meckel's diverticulum, when feasible, in all laparotomies, it has served its purpose. It is hoped that with the gradual correlation of symptoms manifested by this group complex and the spreading of its knowledge, the diagnosis will be made oftener in its earlier phases and surgical treatment will be more efficacious.